Procalcitonin and C-reactive protein to rule out early bacterial coinfection in COVID-19 critically ill patients
Authors: Flavia Galli, Francesco Bindo, Anna Motos, Laia Fernández-Barat, Enric Barbeta, Albert Gabarrús, Adrián Ceccato, Jesús F. Bermejo-Martin, Ricard Ferrer, Jordi Riera, Oscar Peñuelas, José Ángel Lorente, David de Gonzalo-Calvo, Rosario Menéndez, Jessica Gonzalez, Sofia Misuraca, Andrea Palomeque, Rosario Amaya-Villar, José Manuel Añón, Ana Balan Mariño, Carme Barberà, José Barberán, Aaron Blandino Ortiz, Elena Bustamante-Munguira, Jesús Caballero, María Luisa Cantón-Bulnes, Cristina Carbajales Pérez, Nieves Carbonell, Mercedes Catalán-González, Raul de Frutos, Nieves Franco, Cristóbal Galbán, Ana Lopez Lago, Víctor D. Gumucio-Sanguino, Maria del Carmen de la Torre, Emilio Díaz, Ángel Estella, Elena Gallego Curto, José Luis García-Garmendia, José Manuel Gómez, Arturo Huerta, Ruth Noemí Jorge García, Ana Loza-Vázquez, Judith Marin-Corral, María Cruz Martin Delgado, Amalia Martínez de la Gándara, Ignacio Martínez Varela, Juan Lopez Messa, Guillermo M. Albaiceta, María Teresa Nieto, Mariana Andrea Novo, Yhivian Peñasco, Felipe Pérez-García, Juan Carlos Pozo-Laderas, Pilar Ricart, Victor Sagredo, Angel Sánchez-Miralles, Susana Sancho Chinesta, Ferran Roche-Campo, Lorenzo Socias, Jordi Solé-Violan, Fernando Suarez-Sipmann, Luis Tamayo Lomas, José Trenado, Alejandro Úbeda, Luis Jorge Valdivia, Pablo Vidal, Maria Victoria Boado, Alejandro Rodríguez, Massimo Antonelli, Francesco Blasi, Ferran Barbé, Antoni Torres, Rafael Mañez, Felipe Rodríguez de Castro, María Mora Aznar, Mateu Torres, María Martinez, Cynthia Alegre, Sofía Contreras, Javier Trujillano, Montse Vallverdú, Miguel León, Mariona Badía, Begoña Balsera, Lluís Servià, Judit Vilanova, Silvia Rodríguez, Neus Montserrat, Silvia Iglesias, Javier Prados, Sula Carvalho, Mar Miralbés, Josman Monclou, Gabriel Jiménez, Jordi Codina, Estela Val, Pablo Pagliarani, Jorge Rubio, Dulce Morales, Andrés Pujol, Àngels Furro, Beatriz García, Gerard Torres, Javier Vengoechea, Silvia Gomez, Lorena Forcelledo Espina, Emilio García Prieto, Paula Martín Vicente, Cecilia Del Busto Martínez, María Aguilar Cabello, Carmen Eulalia Martínez Fernández, María Luisa Blasco Cortés, Ainhoa Serrano Lázaro, Mar Juan Díaz, María Teresa Bouza Vieiro, Inés Esmorís Arijón, David Campi Hermoso, Rafaela Nogueras Salinas, Teresa Farre Monjo, Ramon Nogue Bou, Gregorio Marco Naya, Núria Ramon Coll, Juan Carlos Montejo-González, Gloria Renedo Sanchez-Giron, Juan Bustamante-Munguira, Ramon Cicuendez Avila, Nuria Mamolar Herrera, Alexander Agrifoglio, Lucia Cachafeiro, Emilio Maseda, Albert Figueras, Maria Teresa Janer, Laura Soliva, Marta Ocón, Luisa Clar, JIgnacio Ayestarán, Sandra Campos Fernández, Eva Forcadell-Ferreres, Immaculada Salvador-Adell, Neus Bofill, Berta Adell-Serrano, Josep Pedregosa Díaz, Núria Casacuberta-Barberà, Luis Urrelo-Cerrón, Àngels Piñol-Tena, Pablo Ryan Murúa, Covadonga Rodríguez Ruíz, Laura Carrión García, Juan Ilazo Álvarez, Desire Macias Guerrero, Daniel Tognetti, Carlos García Redruello, David Mosquera Rodríguez, Eva María Menor Fernández, Sabela Vara Adrio, Vanesa Gómez Casal, Marta Segura Pensado, María Digna Rivas Vilas, Amaia García Sagastume, Raul de Pablo Sánchez, David Pestaña Laguna, Tommaso Bardi, Carmen Gómez Gonzalez, Maria Luisa Gascón Castillo, José Garnacho-Montero, Joan Ramon Masclans, Ana Salazar Degracia, Judit Bigas, Rosana Muñoz-Bermúdez, Clara Vilà-Vilardel, Francisco Parrilla, Irene Dot, Ana Zapatero, Yolanda Díaz, María Pilar Gracia, Purificación Pérez, Andrea Castellví, Cristina Climent, Lidia Serra, Laura Barbena, Iosune Cano, Alba Herraiz, Pilar Marcos, Laura Rodríguez, Maria Teresa Sariñena, Ana Sánchez, Juan Fernando Masa Jimenez, Gemma Gomà, Mercedes Ibarz, Diego De Mendoza, Victoria Alcaraz-Serrano, Joan Ramon Badia, Manuel Castella, Leticia Bueno, Catia Cillóniz, Pamela Conde, Javier Fernández, Karsa Kiarostami, Alexandre López-Gavín, Cecilia L. Mantellini, Carla Speziale, Nil Vázquez, Hua Yang, Minlan Yang, Carlos Ferrando, Pedro Castro, Marta Arrieta, Jose Maria Nicolas, Rut Andrea, Marta Barroso, Sergio Álvarez, Dario Garcia-Gasulla, Adrián Tormos, Cesar Aldecoa, Rubén Herrán-Monge, José Ángel Berezo García, Pedro Enríquez Giraudo, Pablo Cardinal Fernández, Alberto Rubio López, Orville Báez Pravia, Leire Pérez Bastida, Antonjo Alvarez Ruiz, Anna Parera Pous, Ana López Lago, Eva Saborido Paz, Patricia Barral Segade, Manuel Valledor Mendez, Luciano Aguilera, Esther López-Ramos, Ángela Leonor Ruiz-García, Belén Beteré, Rafael Blancas, Cristina Dólera, Gloria Perez Planelles, Enrique Marmol Peis, Maria Dolores Martinez Juan, Miriam Ruiz Miralles, Eva Perez Rubio, Maria Van der Hofstadt Martin-Montalvo, Tatiana Villada Warrington, Sara Guadalupe Moreno Cano, Federico Gordo, Basilisa Martinez Palacios, Maria Teresa Nieto, Sergio Ossa, Ana Ortega, Miguel Sanchez, Bitor Santacoloma
Journal: Intensive Care Medicine (2023)

Although the prevalence of community-acquired respiratory bacterial coinfection upon hospital admission in patients with coronavirus disease 2019 (COVID-19) has been reported to be < 5%, almost three-quarters of patients received antibiotics. We aim to investigate whether procalcitonin (PCT) or C-reactive protein (CRP) upon admission could be helpful biomarkers to identify bacterial coinfection among patients with COVID-19 pneumonia. We carried out a multicentre, observational cohort study including consecutive COVID-19 patients admitted to 55 Spanish intensive care units (ICUs). The primary outcome was to explore whether PCT or CRP serum levels upon hospital admission could predict bacterial coinfection among patients with COVID-19 pneumonia. The secondary outcome was the evaluation of their association with mortality. We also conducted subgroups analyses in higher risk profile populations. Between 5 February 2020 and 21 December 2021, 4076 patients were included, 133 (3%) of whom presented bacterial coinfection. PCT and CRP had low area under curve (AUC) scores at the receiver operating characteristic (ROC) curve analysis [0.57 (95% confidence interval (CI) 0.51–0.61) and 0.6 (95% CI, 0.55–0.64), respectively], but high negative predictive values (NPV) [97.5% (95% CI 96.5–98.5) and 98.2% (95% CI 97.5–98.9) for PCT and CRP, respectively]. CRP alone was associated with bacterial coinfection (OR 2, 95% CI 1.25–3.19; p = 0.004). The overall 15, 30 and 90 days mortality had a higher trend in the bacterial coinfection group, but without significant difference. PCT ≥ 0.12 ng/mL was associated with higher 90 days mortality. Our study suggests that measurements of PCT and CRP, alone and at a single time point, are not useful for ruling in or out bacterial coinfection in viral pneumonia by COVID-19.